We have BCBS and at the time had a select choice policy in which anything other than our two local clinic/hospital providers were considered out of network and we had to pay a higher copay, percentage for going out of network. With his vest though, we thought we'd have to pay 20% of the DME (durable medical equipment) cost. In working with Hill-Rom, they explained that the majority of the time, the vest is denied initially and then there's an appeal process. We had to submit information regarding hospitalizations, exacerbations, specifics on infections -- they needed to know he was on Tobi, I seem to recall. Then once they sent the vest, there were still questions as to our costs, if insurance was going to cover it. For the first year we got calls asking the number of hours of usage. Finally after the year was up we received a letter indicating the vest was ours. Not sure what our percentage was -- I know it wasn't 20%. My advice is to appeal, appeal, appeal. The vest companies and your clinic should work with you.
